An Open Hand

Published: May 6, 2009

Malis lay, as usual, on her side in a contorted half-fetal position, her far arm thrown across her tiny body to grasp the iron rail of the hospice bed. Her head had fallen off the pillow, so her open eyes fixed on the tile floor. Medically, one could describe her as a 35-year-old AIDS patient, recovering from tuberculosis of the lymph nodes and partial paralysis from a stroke. She is also a wife and a mother. Yet her husband has left her for another woman; she no longer sees her children.

She’s sick. She’s depressed. She’s abandoned.

I walked into Malis’ room, sat cross-legged on the tile floor, and looked into her big, sad yet beautiful eyes. I inched my hand closer to hers, as it now only loosely draped over the guardrail. I didn’t hold her hand, for that action should be her dignified choice. I did start singing. Though I knew I shouldn’t choose a Christian hymn in a Buddhist culture, she wouldn’t understand English so I let myself sing the first thing that came to mind — “On Eagle’s Wings.” “And He will raise you up on eagle’s wings, bear you on the breath of dawn, make you to shine like the sun, and hold you in the palm of his hand.”

By the end, Malis slid her dainty fingers into my open palm.

Nearly every weekday afternoon, as part of my assignment in the Center for Social Concerns’ International Summer Service Learning Program, I went to the Seedling of Hope HIV/AIDS hospice in Phnom Penh. In a place staffed by doctors, a nurse and diligent caregivers, I had no obvious role. My Khmer language was limited at best and my medical skill nonexistent. I was told I could just “be with” the patients, maybe create some activities to do with them if they felt well enough. Those ideas terrified me — how could I help at all if I could barely communicate? Why would these already vulnerable people even want me in their lives?

Yet one day I brought materials to make silk flowers. I showed my samples to a few ladies and put one in the hands of Phalla, a 27-year-old woman who had gone blind from an opportunistic cytomegalovirus (CMV) infection. Immediately, she said, “Kynohm jang twau pkaa” (I want to make flowers). I guided her hands the first time, but she caught on quickly. Then I just watched her wrap the silk around wire loops. Other patients and caregivers came to watch and contribute to our growing community bouquet. I mostly studied Phalla’s intense concentration and slightly concealed smile.

Across language and cultural barriers, Phary and I became friends. I sat on her bed; she talked to me in Khmer; I understood some and replied; we laughed; I braided her hair; we cuddled like two little girls at a slumber party. Each day, she gave me updates on Malis, her roommate: telling me whether Malis had eaten that day or had been too depressed and angry, refusing food.

I spent some entire afternoons with Malis, though she never spoke to me. Sometimes I sang. Sometimes I just sat. I changed her diaper, her shirt and her sheets. I rubbed lotion and gentian violet on her breaking bedsore. But I never held her hand; I only opened my hand for her to take. She often did, stroking my palm with her delicate, gentle fingers.

At one point, Malis stopped eating for so long that I thought she was deliberately starving herself to death. Though she did eventually start eating again — always intermittently — I constantly worried about her. She’s treated for AIDS and her other ailments, but what about the pain of abandonment? What will that do to her? What could I possibly do for her?

In the lingo of work on international poverty, we throw around such catchphrases as implementation strategies, sustainable growth and equitable global partnerships. We discuss authentic development as a liberating social process rooted in ensuring both civil and political and social and economic human rights. Following from this development language are effective solutions: ways we can actually reduce poverty. Such measures are fruitful and essential.

But in Malis’ room, no catchphrase or ready-made solution mattered. She lay, partly paralyzed by illness and fully paralyzed by grief. She was suffering. All I could do was gaze into her eyes and open my hand.

A privilege

In going to Cambodia, where need is so desperate, I wanted to be useful. Yet once I realized my language and skill limitations, I found a different role — a privilege really. My privilege was to learn from people who know what it means to simply survive. What a humbling gift, the gift of awareness. For sitting by Malis’ bed, I couldn’t begin to imagine what she felt like, but I knew she suffered. Really knowing a person — with unmet needs, struggles and sufferings — is the first part of the critical awareness I learned in Cambodia. Though I couldn’t really help them, to love Phalla and to love Malis is at least to know their value as people.

However, awareness goes beyond grasping another’s suffering. In interpreting the Matthew 25 parable of the last judgment, Father Gustavo Gutierrez writes, “to fail to act for another is as culpable as expressly refusing to do it.” The difficulty is discovering how to act.

Just as I approached Malis with an open hand, I approached Cambodia with open eyes. Riding on the back of a moto through any part of Phnom Penh made it impossible to remain unaware of poverty. The egg seller and the grilled banana seller trying to earn meager livings. The crippled street beggars. The barefoot children collecting recyclables to turn in for a few hundred riel.

The poverty I saw in Cambodia goes beyond lack of money. Nobel-prize-winning economist Amartya Sen defines poverty as “the deprivation of basic capabilities rather than merely a lowness of income.” Thus, aid money alone, while essential, won’t give the poor their denied freedoms: structural change must take place. The first step in reforming structures is building a critical awareness of the problems, and, from that, finding a starting point for change.

Education, health care, unemployment, resettlement — I constantly learned about Cambodia’s confounding systems of inequality. Yet perhaps nowhere was injustice so glaring as at Stung Meanchey, the Phnom Penh garbage dump. Hundreds of families live around the massive refuse heap, and each day adults and children walk through the garbage in search of recyclables, their only source of income.

I met a small community living off this dump and walked through the slop past their tiny stick shacks to see 7- by-7-foot rooms that housed two families. One toddler cried around her mother’s legs, flies buzzing around her face; she had night fevers, possibly a sign of tuberculosis. I crouched down to smile at her, but she only wailed harder.

The why questions

At Stung Meanchey, unlike at the hospice, there were no well-organized systems for helping people rebuild their lives. Few nongovernmental organizations (NGOs) work with this community in Stung Meanchey, so here analysis of structural problems is even more crucial. Someone has to find a starting point. Thinking through the social analysis process, I asked many “why” questions. Why do the people have no option but to live in a dump? Why are so few NGOs working in the area? If that little girl has TB, why can’t she get medicine?

With these critical “whys” comes one “where” question: I want to help, but where can start? In seven weeks, maybe I couldn’t give the people better means of employment. But partly from reading the development literature by experts like Jeffrey Sachs, I do appreciate that very basic improvements can give poor people a little more dignity. I thought I could find one of these simple solutions.

One day, while several adults discussed possible improvements to the area, a little girl holding my hand whispered to me. I tried to understand her Khmer, but had to ask someone to translate.

“Please, one bednet and one roof.”

In that moment, I became aware of a responsibility I had never felt before. The unjust social structures that cause her suffering result in part from my country’s policies. As a U.S. citizen, especially given my country’s history of involvement in Southeast Asia, the girl’s suffering is partly my fault and my responsibility.

My Notre Dame site partner, Megan O’Hara, Class of 2008, and our friends Jen and Katrine pooled in to get mosquito nets and roofs for the families, a modest start. But even failures from that simple effort taught me the difficulty of moving from awareness of a structural problem to beginning to effect change. We learned we couldn’t obtain the official insecticide-treated nets because they were reserved for the northern provinces, where malaria is rampant. So we had to settle for simple bed nets from the local market. We also learned that mosquito vectors for dengue fever — Cambodia’s current plague — mostly bite during the daytime. While providing relief against the discomfort of mosquito bites, the nets would have little efficacy in disease prevention.

We hoped to attempt to learn from the government dengue center if Stung Meanchey had been sprayed with insecticide. However, when I spoke with Dr. Beat Richner, whose pediatric hospitals are the major dengue treatment centers, I learned prevention methods have reached little of the planned coverage. Spraying in a garbage dump was unlikely. As for the roofs, we wanted corrugated tin to protect the people from Cambodia’s torrential rains. However, we found their huts were so small and low to the ground that tin would make the dwellings unbearably hot — so we got tarp, which doesn’t really prevent flooding. If only we could have built new houses.

Now back at Notre Dame, half a world away from Stung Meanchey, I understand that I can’t create an entire support structure where there is none. Every effort needs its actors on the ground, working in the dirt of the community. However, the last and most important part of critical awareness I found that summer gives me hope for the way we can effect change: through dedicated effort and partnership.

The will for action

My greatest blessing was meeting 30 of the most hardworking young adults I know: the Royal University of Phnom Penh students in my English classes, which focused on world affairs. Teaching them was the other part of my International Summer Service Learning Program, and enabling them to work for a better Cambodia was a way to move from awareness to action.

These students know the value of an education — and so much more. Most came from the rural provinces of Cambodia, far from the more developed capital city. In primary school, they learned by rote copying and repetition; creativity and critical thinking were rarities. While most U.S. children enjoy after-school soccer leagues or neighborhood games, these students spent their free time on household work and studying. Even at young ages, they understood their lack of options if they failed to get an education.

Some came from a background of tragedy. One young man was born and raised in a refugee camp on the Thai border, as his family escaped the civil war of the 1980s. A landmine killed another young man’s father. Another wrote an essay about being caught in a battle between Khmer Rouge rebels and government forces. He was separated from his family, and landmines kept him from his hometown for so long that he couldn’t begin school until he was 9 years old. He ended one paper with, “I hate war so much.”

I was given the chance to share ideas with these students on war and genocide, on environmental crises, on education, on gender inequality and human trafficking, on human rights. They understand the problems — both in their country and in the world. They know what has to be done. And they have the will to do it.

If many more people in rich countries could be critically aware of their responsibility for the world’s poor, and if they would take basic action in political and social advocacy, then people like my students could do the rest of the work.

On the last day of class, we sat in a small circle and talked about our dreams. Every single student wanted to do something in the future to help impoverished people in their country. Many expressed desires to be teachers, to help give Cambodian children a better education. Many wanted to work for NGOs. A couple students shyly confessed their goal to become politicians; the rest of the class was quick to reassure them that Cambodia needs uncorrupt officials, so wanting to work in government is not taboo! Those studying information technology said they wanted to make better technology more accessible to the public.

All my students saw roles for themselves in improving their country’s future. Whether or not they achieve their goals depends in part on our awareness of their needs. People in rich countries need to understand all the obstacles — violence, disease and sheer poverty — that prevent people in poor countries from receiving an education and finding valuable employment. It’s hard to become a virtuous politician when you’re growing up in a garbage dump. With true awareness of the complex problems — and our complicity in creating them — maybe we can make it possible for people like my students to change the unjust and oppressive structures.

I must keep doing more, but in my short time in Cambodia I could not help people liberate themselves from the oppression of poverty. All I could really do was open my eyes and open my hands. I grew aware of the individual suffering of beautiful people; I grew aware of the complexity of institutionalized poverty, and both the difficulty and necessity of finding a starting point for action; finally, I grew aware of the potential for change, through working with Cambodia’s young but determined future.

I said goodbye to Malis while she was sleeping in her contorted half-fetal position. Several times over the last few days, I had told her in my shaky Khmer why I was leaving, but, as expected, I received no response. So as she slept, arm draped over the guardrail, I told her for the thousandth time, “Kynohm sraa-lan neak” (I love you). I opened my hand, though of course she didn’t take it.